Background: The incidence of septic arthritis is 2e10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. Patients and methods: Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. Discussion: With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2 nd stage reducing hospital stay, morbidity, and cost. Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection. Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. Conclusion: All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.
Heterotopic ossification is the abnormal formation of mature, lamellar bone in nonosseous tissue such as tendons, ligaments, muscles, and soft tissue. We discuss a rare case of a young adolescent with patellar tendon rupture postheterotopic ossification. A 13-year-old male presented to us with knee pain and inability to extend for 6 weeks following trivial trauma. Preliminary radiological investigations revealed a high riding patella with ossification in the patella tendon. The magnetic resonance scan confirmed the same with patellar tendon disruption and heterogeneous ossification. He underwent surgery with patella tendon repair, augmentation with autograft, and had complete recovery at 6 months' follow-up.
Computer aided diagnosis (CAD) is one of the potential technologies in today’s medical world that assist doctors to interpret and evaluate medical images in a short time. CAD offers support to medical professionals to make decisions on possible diseases. Various systems and approaches are implemented to serve this technology, and many hospitals have deployed the system for diagnosis of diseases. The detection of the proportion of disease would aid in determining if more in-depth tests are required for confirmation of the condition, hence avoiding risky biopsies. This survey focuses on such methodologies implemented by authors of several works to detect lung infections by analyzing tissue patterns and inflammations in lungs and classifying the same. Along with this, work related to the patient database system is also reviewed and a comparison is made between the works. Keywords: Computer aided diagnosis, tissue pattern, biopsy
Case report. Objectives: To report a case of chordoma mimicking adenocarcinoma in a 52-year-old woman. Summary of Literature Review: Chordoma, a rare malignant tumor of primitive notochordal origin, accounts for 1-4% of all bone malignancies. Chordoma mimicking esophageal adenocarcinoma in the posterior mediastinum is unique. Materials and Methods: A 52-year-old asymptomatic woman was referred to our center with an incidentally detected posterior mediastinal mass and no significant medical history. The mass was diagnosed on a routine medical screening by esophagogastroduodenoscopy and the patient was receiving yearly follow-up. An increase in size was noticed during the second year of follow-up on endoscopic ultrasonography and the patient was referred to the Department of Gastrointestinal Surgery of our hospital. This paper was written after receiving institutional review board (IRB) approval (KC20ZASI0214). Results: En bloc resection was performed for the growing thoracic mass and pathologic findings confirmed it to be chordoma. A followup computed tomography examination was conducted at 8 months, as well as magnetic resonance imaging at 1 year, and there was no local recurrence. Conclusions: Posterior mediastinal chordoma at the thoracic level is very rare. Furthermore, it is difficult to diagnose because its immunohistochemical characteristics mimic those of esophageal adenocarcinoma, meaning that it can be missed. Management is a challenge due to its anatomical location and additional local invasion. Therefore, a multidisciplinary approach is needed, including careful consultation with the patient to provide the optimal treatment for the best possible outcome.
Objectives:
The outcome of revision anterior cruciate ligament reconstruction (ACLR) is inferior to that of the primary reconstruction and is influenced by multiple factors. The purpose of this study was to identify the better autograft suited for revision ACLR and to assess the factors influencing the outcome of revision.
Methods:
A total of 102 patients who underwent revision ACLR were enrolled in this study. The patients were grouped based on the type of autograft used for revision. The mechanism of injury and the cause of the primary ACLR failure, meniscal, and chondral status were noted. All patients’ Tegner Lysholm functional scores were assessed at 2 years of follow-up.
Results:
Almost 37.3% of the patients underwent revision ACLR with bone-patellar tendon bone, 41.3% with semitendinosus-gracilis, and 21.3% with quadriceps tendon autografts. The mean Tegner-Lysholm score was 85.4 ± 15.8, with the majority achieving good to excellent scores. Chondral defect of Grade 3/4 was associated with an inferior poorer functional outcome (P = 0.03). At a 2-year follow-up, the non-contact mechanism of primary ACLR failure was associated with worse scores compared to the contact mechanism of failure (P = 0.03). On comparison of Lysholm functional score between different autografts using the Kruskal-Wallis test, the p-value was insignificant (P = 0.9).
Conclusion:
Non-contact mechanism of primary ACLR failure and Grade 3/4 chondral defects was associated with a poorer functional outcome at 2 years post-revision ACLR. The overall functional outcome of revision ACLR was good to excellent in our Middle East Asian population, with no one autograft found to be superior to the other.
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